Administering & Dispensing Medications

[Pages:19]NOVEMBER 2014

Administering & Dispensing Medications

P R O F E S S I O N A L P R A C T I C E G U I D E L I N E

COLLEGE OF RESPIRATORy ThERAPISTS OF ONTARIO

Administering & Dispensing Medications Professional Practice Guideline

Professional Practice Guideline

College of Respiratory Therapists of Ontario (CRTO) publications contain practice parameters and standards which should be considered by all Ontario Respiratory Therapists in the care of their patients/clients and in the practice of the profession. CRTO publications are developed in consultation with professional practice leaders and describe current professional expectations. It is important to note that these CRTO publications may be used by the CRTO or other bodies in determining whether appropriate standards of practice and professional responsibilities have been maintained. Resources and references are hyperlinked to the Internet for convenience and referenced to encourage exploration of information related to individual areas of practice and/or interests. Bolded terms are defined in the Glossary.

It is important to note that employers may have policies related to an RT's ability to accept delegation to dispense medications. If an employer's policies are more restrictive than the CRTO's expectations, the RT must abide by the employer's policies. Where an employer's policies are more permissive than the expectations of the CRTO, the RT must adhere to the expectations of the CRTO.

2nd Revision: November 2014 Originally Published: 2005

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Administering & Dispensing Medications Professional Practice Guideline

table of contents

INTRODUCTION

4

ADMINISTRATION

5

The 9 "Rights" of Competent Medication Administration

6

Medication Management Systems

6

Oral and Topical Medication

6

Over the Counter (OTC) Medication

7

DISPENSING

8

When it's Appropriate for an RT to Dispense

8

Accepting Delegation to Dispense

9

Who an RT Can Accept Delegation From

9

TABLE 1: Who can order medication and who can order dispensing medication. 10

Orders for Dispensing

10

Factors to Consider when Accepting Delegation to Dispense

10

Labeling dispensed medication

11

Safe storage and handling

11

DOCUMENTATION

12

DISPENSING PROCESS MAP

13

SPECIAL CONSIDERATIONS

14

Substitution Policies

14

Repackaging

14

Narcotics and other Controlled Substances

14

Dispensing Samples

15

Medication Errors

16

Glossary

17

References

18

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Administering & Dispensing Medications Professional Practice Guideline

Introduction

The Regulated Health Professions Act, 1991 (RHPA) identifies thirteen controlled acts that pose significant risk of harm to the public of Ontario [RHPA section 27(2)]. Dispensing medications falls under the 8th controlled act in the RHPA:

"Prescribing, dispensing, selling or compounding a drug as defined in the Drug and Pharmacies Regulation Act, or supervising the part of a pharmacy where such drugs are kept."

The Respiratory Therapy Act, 1991 (RTA) does not authorize Respiratory Therapists (RTs) to perform this controlled act, the authority to dispense medications must be delegated to an RT from another regulated health care professional that is authorized to dispense and to delegate dispensing (i.e., physicians). Therefore, RT's can only receive delegation for the dispensing portion of this controlled act. Respiratory Therapists must not prescribe, sell or compound a drug, or supervise the part of a pharmacy where such drugs are kept.

Please Note...

Other regulated health care professionals who are authorized to perform this controlled act in its entirety, or parts of it, have additional regulations and standards guiding these practices. For example, only Pharmacists and wholesalers are permitted to sell medications. Selling implies the possession of the medication. RTs cannot accept payment for medications dispensed or invoice clients on behalf of their employers.

For additional information, please see the Interpretation of Authorized Acts and Delegation of Controlled Acts Professional Practice Guidelines (PPGs).

Other legislation regulating the practices of prescribing, dispensing, selling, or compounding a drug, and supervising a pharmacy, includes but is not limited to:

Provincial Legislation: ? Pharmacy Act, 1991 ? Drug and Pharmacies Regulation Act, 1990 ? Drug Interchangeability and Dispensing Fee Act, 1990 ? Narcotics Safety and Awareness Act, 2010

Federal Legislation: ? Food and Drugs Act, 1985 ? Controlled Drugs and Substances Act, 1996 ? Narcotics Control Regulation (amended 2014)

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Administering & Dispensing Medications Professional Practice Guideline

ADMINISTRATION

RTs commonly administer medications via the authority granted to them by the Respiratory Therapy Act - "administering a substance by injection or inhalation" [s.4 (4)]. Dispensing occurs less often, and will be explained later in this PPG. RTs are responsible for administering medications within both their personal and professional scope of practice. The safe and competent administration of medication requires the RT to have the competencies (knowledge, skill and abilities) to:

? assess the appropriateness of a particular medication for the patient/client, including indications and contraindications;

Examples of administering medication:

? Obtaining, preparing and administering a narcotic for use during conscious sedation of a patient/client

? Obtaining, preparing and administering a drug from a supervised hospital or departmental "stock" of medications (e.g. sedatives kept in a bronchoscopy suite for use during an outpatient procedure)

? be aware of the actions, interactions, dose, route, side-effects and adverse effects of the drug;

? be able to calculate the correct dosage and prepare the medication correctly, when necessary; and

? to monitor the patient/client during and following administration, as well as manage any side-effects or adverse reactions to the drug, intervening when necessary.

* Prior to administering any substance, the Respiratory Therapy Act requires RTs to obtain a valid order (direct order or medical directive) from:

(a) a member of the College of Physicians and Surgeons of Ontario, the College of Midwives of Ontario or the Royal College of Dental Surgeons of Ontario;

(b) a member of the College of Nurses of Ontario who holds an extended certificate of registration under the Nursing Act, 1991; or

(c) a member of a health profession that is prescribed by regulation.

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Administering & Dispensing Medications Professional Practice Guideline

Please Note...

Dispensing can only occur once. After a drug is labeled and dispensed to a patient/client via an automated medication dispensing unit, physically giving the medication to the patient/client is administration, not dispensing.

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The 9 "Rights" of Competent Medication Administration

1. right PATIENT/CLIENT ?should be at least two unique identifiers (not room number);

2. right MEDICATION to be given - compare Medication Administration Record (MAR) with order;

3. right ROUTE? includes site (e.g., IV, IM); 4. right TIME/ DAY ? includes frequency; 5. right DOSE ? check calculation and label; 6. right DOCUMENTATION ? i.e. after medication is administered; 7. right FORM ? e.g. liquid, tablet, etc.; 8. right REASON ? to treat the appropriate condition; and 9. right RESPONSE - monitor to ensure that the medication has the desired

effect1.

Medication Management Systems

Most facilities now use some form of medication management system, which usually includes an automated medication dispensing unit. The purpose of implementing this type of delivery system is to avoid preventable medication errors and improve patient safety. The pharmacy receives the medication order electronically from the physician and dispenses the medication into the unit. The medication can then be accessed by staff to be administered when needed.

Oral and Topical Medication

Administration of a substance orally or topically is not a controlled act under the RHPA and is not considered dispensing unless a supply was given to the patient/client to take at another time. An RT may assist a patient/client in taking their prescribed tablets at the time they are due; however, an RT may not leave extra tablets from a stock at the bedside for the patient/client to take. As with all other medications, to administer oral (e.g., Prednisone) and topical medications (e.g., Lidocaine) the RT needs to know the indications, contraindications, proper dosages and potential side-effects. The prescription and medication container must be checked, along with the patient/client's identity and any potential allergies/drug sensitivities, as with any other medication. Oral medications in a tablet form should be given to the patient in a disposable container, and liquid preparations should be measured using syringes specifically designed for that purpose. The RT must ensure that the medication was taken by the patient/client as directed, and document accordingly.

1 Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B. T. (2008). Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423..

Administering & Dispensing Medications Professional Practice Guideline

Over the Counter (OTC) Medication

OTC refers to medications that can be obtained in the community without a prescription from an authorized regulated health care professional. However, in a hospital setting an order is still required to administer an OTC medication. Many facilities also have policies requiring that any OTC medication brought in from home by a patient/client must be sent to the pharmacy for labelling, and then approved by the most responsible physician before returning it to the patient/client. If an RT is giving out OTC medication in a community setting (e.g., nicotine replacement therapy or NRT in an outpatient smoking cessation clinic), they are responsible for ensuring the medication is stored securely and must dispose of any medication that is past its expiry date. For more information, please see the section on Safe Storage and Handling.

Q&A

Q: In order for me to hand out OTC NRT in our Family Health Team, do I need to get delegation to dispense? A: OTC medication does not require an order from a physician in the community and is not "dispensed". Therefore, RTs do not need delegation in order to provide OTC NRT to a patient/client to take home.

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Administering & Dispensing Medications Professional Practice Guideline

Example:

Allowing a patient/client to take home a properly labeled metered dose inhaler from the Emergency Department stock after counseling a patient/client about their prescription and medication.

DISPENSING

RTs do not have the legislative authority to dispense medication, but can receive delegation to dispense. RTs may dispense medications when it's in the best interest of the patient/client, such as a patient/client having difficulty accessing a pharmacy.

Dispensing is a controlled act that authorizes an RT to select, prepare and provide stock medication that has been prescribed to a patient/client (or his or her representative) for administration at a later time.

The process of dispensing has both technical and cognitive components. The technical component includes tasks such as receiving and reading the prescription, selecting the drug to dispense, checking the expiry date, labeling the product, and record keeping.

The cognitive component of dispensing involves assessing the therapeutic appropriateness of the prescription, applying approved substitution policies, being able to make recommendations to the prescriber and advising the patient/client.

When it's Appropriate for an RT to Dispense

Please note...

Only RRT Members of the CRTO (subject to any terms, conditions and limitations on his/her certificate of registration that are related to accepting delegation and/or dispensing) may receive delegation to dispense medications.

Example:

Providing a patient/client with a pharmaceutically supplied sample of a medication to take home from an asthma clinic. (For more information, please see the section on Dispensing Samples.)

Registered Respiratory Therapists (RRTs) require delegation to dispense medication. It is important to note that Graduate Respiratory Therapists (GRTs) cannot accept delegation for any controlled act, including dispensing.

Depending on an RT's personal scope of practice, it may be practical and in the best interest of the patient/client for an RT to accept delegation to dispense medications in certain practice settings, such as:

? hospital emergency departments; ? asthma care centres; ? pulmonary function laboratories; ? cystic fibrosis care centres; ? respiratory rehabilitation centres; ? COPD care centres; ? polysomnography laboratories; and ? Family Health Team (FHT).

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